Consultation-liaison psychiatrists who work in the emergency room and inpatient medical units are commonly confronted with consultations to assist in management of functional neurological disorders. While some of these conditions represent life-long patterns of maladaptive coping, there are patients for whom early intensive intervention can produce significant improvements in physical and psychological functioning. The traditional route to treatment includes management of comorbid psychiatric conditions, referral to outpatient psychotherapy, and consistent outpatient medical follow up. For a subset of patients, however, more acute resolution of symptoms is possible using a combination of specific psychoeducation, suggestion, and use of anxiolytic medications to rapidly improve psychogenic symptoms.
In this session, CL psychiatrists and neurologists will discuss the phenomenology, etiology, bedside assessment, acute management, and limitations in treatment for functional neurological disorders.
Dr. John Smith, MD, Assistant Professor of Psychiatry at Vanderbilt University Medical Center, will discuss in brief the history and phenomenology of conversion disorder and the scope of the problem for acute care centers. (10 min)
Dr. Derek Riebau, MD, Director of the Neurology Residency Program at Vanderbilt University Medical Center, will discuss typical workup for suspected conversion disorders and demonstrate techniques for bedside assessment of functional neurological symptoms. (20 min)
Dr. Stephen Nicolson, MD, FACLP, Beth Israel Deaconess Hospital Plymouth, will discuss the standard of care in treatment of conversion disorder including limitations in what may be offered in acute care settings. (20 min)
Dr. Amanda Wilson, MD, Assistant Professor of Emergency Medicine and Psychiatry at Vanderbilt University Medical Center, will introduce a technique for acute management of functional neurological symptoms using anxiolytic medication, suggestion, and psychoeducation. (20 min)
Dr. Smith will then facilitate an interactive discussion of the audience in which participants will be asked to share their own experience with managing functional symptoms in the acute setting, other techniques for management, and ethical issues around management of this patient population. (20 min)